Other Public Health Resources

CMO Health Services Help Lines

Georgia’s Care Management Organizations (CMOs), WellCare, Amerigroup, and PeachState, have 24-Hour Nurse Help Lines to offer information to members on health care matters. Also available on their websites are provider manuals, which may be of assistance to your front office staff. For additional information on this service for you and your patients, please contact the CMO directly.

24 hour CMO
Nurse Health Services Contact information and Provider information:

PeachState Health Plan, Nursewise 800-704-1484, Option 7

PeachState Provider Manual, see page 8 for Provider Responsibilities:

Americgroup Nurse Help Line 800-600-4441

Amerigroup Provider Manual, see page 24 for CM/Disease Management information:

WellCare Health Advice Line 800-919-8807

Quick Reference Guide for the provider hotline, claims, utilization management and customer service:

March 5, 2010

Guide for Addressing Senior Drivers Now Available

The Georgia Older Drivers Task Force (ODTF) is offering the “Physicians’ Guide for Assessing and Counseling Older Drivers’” CD, which includes a practical and easily administered plan for assessing older drivers as well as the legal and ethical responsibilities of Georgia physicians with regard to the safety of older drivers.

The resource was designed for primary care physicians by a task force that was established as part of Gov. Sonny Perdue’s Strategic Highway Safety Plan to educate older drivers and physicians. The CD PowerPoint Presentation can be obtained by contacting Herb Karp, MD, at (678) 527-3428 or hkarp@gaqio.sdps.org.

March 3, 2010

Mandatory STD Reporting in Georgia

In 2008, a total of 45,291 positive test results were reported by Georgia physicians, laboratories, and health care providers. All Georgia physicians, laboratories, and health care providers are required by law to report patients with Syphilis (adult and congenital), chlamydia, gonorrhea, chancroid and lymphogranuloma venereum (LGV).

Both lab-confirmed and clinical diagnoses are reportable within the following time intervals:

Report immediately – syphilis
Report within 7 days - chlamydia, gonorrhea, chancroid and LGV

Reports should include:

Patient demographics

Laboratory information

Symptom history

Treatment information

Physicians can report STD cases one of three way:

Electronically through the State Electronic Notifiable Disease Surveillance System at http://sendss.state.ga.us (Preferred Method);
By fax to the local District Health Office;
By mail, in an envelope marked CONFIDENTIAL to the local District Health Office.

To locate the District Health Office in your area, visit the Division of Public Health website at: www.health.state.ga.us/pdfs/epi/notifiable/ND%20Reporting%20Form.pdf

Although laboratories also are required to report STDs, provider case reporting enables health departments to receive complete demographic, diagnostic, and treatment information on patients. Complete case reporting increases the timeliness of health department STD intervention and assists with rapid identification of STD outbreaks in the community. It also provides a better understanding of disease trends in Georgia.

Each local health district offers partner services to individuals who are infected with a STD, infected individuals partners, and other persons who are at increased risk for infection. These services prevent transmission of STDs and reduce suffering from complications. A critical function of partner services is partner notification, a process by which infected persons are interviewed to elicit information about their partners, who can then be confidentially notified of their possible exposure or potential risk. Other functions of partner services include prevention counseling and referral to other prevention and support services.

For the latest information from the Department of Community Health, Division of Public Health, visit www.health.state.ga.us. For additional information or assistance contact: Linda Allen-Johnson, EPI/STD Surveillance Unit, Department of Community Health, Division of Public Health at lallen-johnson@dhr.state.ga.us.

January 28, 2010

Whooping Cough Booster Shot Recommended for Adolescents and Adults

Survey Shows Most Adults Don’t Know that Whooping Cough Remains Widespread in the United States

ATLANTA, GA--(November 9, 2009) -Many people may think of whooping cough as a disease of the past – something eradicated generations ago. However, the number of cases reported by the Centers for Disease Control and Prevention (CDC) indicate that whooping cough is still very much a public health concern; health experts estimate that up to 600,000 cases occur each year in adults alone. In Georgia, whooping cough cases are on the rise. According to the Georgia Division of Public Health, the number of whooping cough cases in the state in the first half of this year is more than double that of the same time period last year.

To help protect against whooping cough, the CDC and the American Academy of Family Physicians (AAFP) recommend that most adolescents and adults get a single dose of the whooping cough vaccine, also called “Tdap” vaccine (tetanus, diphtheria, acellular pertussis). Tdap is a one-time booster shot that is recommended for most adolescents and adults, if not previously vaccinated. For adults, it is recommended to replace a single dose of Td vaccine (tetanus and diphtheria toxoids) if they received their last dose of Td more than 10 years earlier and they have not previously received Tdap.

“It’s important that adolescents and adults are vaccinated against whooping cough to help boost immunity from this contagious disease,” said Brian K. Nadolne, MD, Family Medicine Department at Northside Hospital, Nadolne Family Medicine and Preventive Care, Georgia. “Many adults and adolescents may not know that there is a one-time booster shot that offers protection against whooping cough.”

The AAFP, with help from the Georgia chapter, has launched “Vaccination Matters: Help Protect Families from Whooping Cough,” a public health initiative designed to help people understand the importance of whooping cough vaccination for adolescents and adults.

A recent national survey revealed that more than three-quarters of adults (76 percent) didn’t know or didn’t think that whooping cough remains widespread in the United States. Many adults (61 percent) are not even aware that there is a vaccine for whooping cough.

Whooping Cough Can Be Serious
Whooping cough, also known as pertussis, can have a significant impact on a person’s health if contracted. A highly contagious respiratory disease, whooping cough can cause a persistent, hacking cough severe enough to cause vomiting and even break ribs. The illness may last for up to three months or more, and may lead to pneumonia, hospitalization and missed work or school days.

People with whooping cough may not be aware they have it and can spread it to others, including infants and children. Babies who have not received all of their shots for whooping cough are especially vulnerable to complications.

Vaccines Are Not Just For Babies and New Parents
Protection against whooping cough wears off approximately five to 10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to whooping cough. In the survey, 72 percent of adults were unsure or didn’t know this was possible.

The survey found that most adults (73 percent) believed they were up-to-date on their vaccinations. The CDC estimates that only 2.1 percent of adults received a Tdap vaccine between 2005 and 2007. For adults, the Tdap vaccine is recommended to replace a single dose of Td vaccine (tetanus and diphtheria toxoids) if they received their last dose of Td more than 10 years earlier and they have not previously received Tdap.

Family physicians can offer expert information on whooping cough vaccination for adolescents and adults. The Georgia Academy of Family Physicians encourages adults to talk to their physician about whooping cough and the Tdap vaccine.

The “Vaccination Matters: Help Protect Families from Whooping Cough” program is made possible through funding and support from GlaxoSmithKline.

Visit www.FamilyDoctor.org/VaccinationMatters for more information.

Jaunary 8, 2009

Chlamydia Related Infertility

Georgia is ranked 6th in the nation for Chlamydia cases with 42,913 cases reported in 2007. Chlamydia infections, caused by the bacterium Chlamydia trachomatis, may have long-term, serious health consequences for both men and women. Symptoms can be mild or even absent which can lead to permanent damage before it is ever diagnosed.

In women, untreated Chlamydia may migrate into the reproductive tract and lead to Pelvic Inflammatory Disease (PID). PID is the leading preventable cause of infertility in the US. Also, women infected with Chlamydia are up to five times more likely to become infected with HIV, if exposed. In pregnant women, Chlamydia infection places the health of the fetus at risk for pre-term delivery and eye infections. Also, Chlamydia is the leading cause of early infant pneumonia. All pregnant women should be screened for Chlamydia. In men, untreated Chlamydia infections may lead to Epididymitis, resulting in pain, fever, and possibly decreased fertility.

To help prevent the serious consequences of Chlamydia, the CDC recommends screening annually for Chlamydia for all sexually active women age 25 years and older women with risk factors for Chlamydia (a new sex partner or multiple sex partners).

Physicians can report Chlamydia and all other STD cases one of three ways:

Electronically through the State Electronic Notifiable Disease Surveillance System at http://sendss.state.ga.us
Mail in an envelope marked CONFIDENTIAL to the local District Health Office
Fax to the local District Health Office

To locate the District Health Office in your area and obtain a report form, visit the Division of Public Health website at www.health.state.ga.us/pdfs/epi/notifiable/ND%20Reporting%20Form.pdf For more information, visit http://cdc.gov/std/chlamydia/STDFact-Chlamydia.htm or contact Cathi Durham at cdurham@gafp.org

December 10, 2009

Diagnosing and Treating Tuberculosis

Tuberculosis remains a real threat in Georgia today. In 2008, Georgia reported 478 cases of TB; this is nearly the exact number as in 2007 (474) when Georgia had the sixth highest number of reported cases in the US. The Georgia Academy of Family Physicians' Public Health Committee realizes the importance of family physicians possessing knowledge and resources for diagnosing and treating TB. The GAFP website now hosts a PowerPoint presentation, Diagnosing and Treating Tuberculosis in the Primary Care Setting created by Dr. Michael K. Leonard, the Medical Director of the Georgia TB Program. To view, visit: http://www.gafp.org/notifiable_disease_emergency.asp.

This presentation includes valuable information on TB diagnosis and treatment. The Georgia Division of Public Health also provides resources for physicians at http://health.state.ga.us/ which includes the Georgia TB Reference Guide at http://health.state.ga.us/pdfs/epi/tb/tbguide.05.pdf.

For additional information, contact Cathi Durham at cdurham@gafp.org or 800-392-3841.

October 27, 2009

Newborn Screening Provider Education Reminder

View PDF here

May 1, 2009

Savannah Family Physician Opens Doors to Women’s Health Education

In June, GAFP member Dr. Julia Johnson of Savannah, hosted a Lunch and Learn in her office. Cathi Durham, GAFP Director of Outreach, accompanied Public Health coordinators from the Coastal District to present up-to-date information on the eligibility requirements and the referral process for Children 1st, Babies Can’t Wait, Newborn Screening, and Women, Infant and Children (WIC). The Lunch and Learn provided an opportunity for Dr. Johnson and her office staff to learn more about these valuable programs and to meet their district’s coordinators.

If you are interested GAFP staff coordinating a Lunch and Learn in your office, please contact Cathi Durham at 404-321-7445 or cdurham@gafp.org

July 17, 2009

2-day Advanced Disaster Life Support Training

The National Disaster Life Support Foundation is offering Advanced Disaster Life Support training. It is an intensive, 2-day course that allows students to demonstrate competencies in casualty decontamination, specified essential skills, and mass casualty incident information systems/technology applications.

Course Overview:

Day 2 of ADLS® is the "hands on" day of training. Four skills stations reinforce the previous day's learning. These skills stations are as follows:

MASS Triage
Personal Protective Equipment (PPE) and Decontamination
Disaster Skills
Human Patient Simulator

Course Credits: 15.5 AMA PRA Category 1 credits & trade

Pre-requisites: BDLS®

For more information visit: http://www.ndlsf.org/common/content.asp?PAGE=137

July 16, 2009

Together Rx Access® Program Expands Eligibility Income Levels
Prescription Savings Now Available to Even More Uninsured Georgians

The rate of unemployment in Georgia has increased in the past year from six percent to nine percent, resulting in the loss of health benefits for many residents.* As a result, family physicians are seeing an increasing number of uninsured patients who are finding it difficult to stay healthy and to manage chronic disease. To make ends meet, these individuals may be cutting back on filling needed prescription medicines.

Because they engage in personal conversations with uninsured patients on a daily basis, family physicians are uniquely positioned to help uninsured Georgians by connecting them to available health resources, such as prescription assistance programs.

Rx Help for the Uninsured
One free program, Together Rx Access, provides eligible individuals and families with immediate and meaningful savings on prescription products right at their neighborhood pharmacy. In response to the nation’s challenging economic times, the pharmaceutical companies that sponsor the Program recently expanded the eligibility income levels required for enrollment. Now, even more uninsured Georgians are eligible for a Together Rx Access Card.

The new income levels are:

$45,000 for a single person
$60,000 for a family of two
$75,000 for a family of three
$90,000 for a family of four
$105,000 for a family of five

In addition to meeting the expanded income levels, individuals must be legal residents of the United States, and have no public or private prescription coverage, or qualify for Medicare, to be eligible for the Together Rx Access Card.

Together Rx Access FOR GEORGIA Card
In August 2008, the Governor Sonny Perdue and Together Rx Access announced the launch of the Together Rx Access FOR GEORGIA Card, the first state specific Together Rx Access Card. As part of this effort, the State uses existing resources to identify residents who may benefit from the Program. To date, nearly 73,000 Georgians are Together Rx Access FOR GEORGIA cardholders.

Quick and Easy Enrollment
Together Rx Access offers potential cardholders a simple enrollment process. And, no documentation is required.

Visit TogetherRxAccess.com to instantly enroll online.
Call the toll-free phone number 1-800-250-2839.
Complete a short paper application and return it by mail.

A Together Rx Access quick start savings card is also available. Potential enrollees simply detach the Card from a brochure and call the toll-free number to find out if they are eligible, enroll and instantly activate their Card. Family physicians interested in receiving a supply of quick start savings cards, or other enrollment materials for distribution to eligible patients, can visit www.togetherrxaccessonline.com/order/. For more information, visit TogetherRxAccess.com or call 1-800-250-2839. *State Health Facts, www.statehealthfacts.org. Accessed 4/20/2009.

June 17, 2009

Lowering Infant Mortality – It Takes a Village
The GAFP held a Lowering Infant Mortality Rates Focus Group in Savannah, Georgia on March 6. The group was facilitated by Dr. Anne Lang-Dunlop, and attended by eight other clinicians, including Dr. Diane Weems, the Chief Medical Officer for the Coastal Health District of the Department of Human Resources.

Dr. Dunlop provided an overview of her presentation, “Lowering Infant Mortality in Georgia: Strategies in Family Medicine.” The group discussed various aspects of infant mortality rate in Georgia, and agreed that it will ‘take a village’ to improve the situation. The group also agreed that the most important factor in lowering infant mortality rates in Georgia is the underlying maternal health. The mother’s nutrition appears to be a significant issue that can dramatically improve maternal health and thereby improve infant health.

The GAFP will be hosted another Focus Group on April in College Park. To learn more contact Cathi Durham at 404-321-7445, or cdurham@gafp.org.

April 17, 2009

STD Treatment Guidelines
The Department of Human Resources has released its Treatment Guidelines Summary for Sexually Transmitted Diseases. The summary, found inserted in this newsletter, has the CDC recommendations for the treatment of adults and adolescents. These guidelines are intended as a source for clinical guidance; they are not a comprehensive list of all effective regimens. An additional resource for training and consultation in the area of STD clinical management and prevention is available by calling 404-463-0408. For further information, visit DHR/STD Prevention website at http://health.state.ga.us/programs/std/index.asp

April 14, 2009

Letter to Physicians

3/5/09

Dear Physician:

In the past few months there have been 18 reported cases of pertussis among elementary school students in four schools in East Cobb County. These cases were diagnosed primarily by PCR. PCR has some advantages in that it is rapid and believed to be more sensitive than culture, but in most labs the clinical sensitivity and specificity of PCR is unknown.

From 2/19-2/24/09, the Centers for Disease Control and Prevention (CDC) in cooperation with the Georgia Division of Public Health, and Cobb and Douglas Public Health conducted voluntary pertussis testing of actively coughing students at the four elementary schools. The goal of this evaluation was to confirm if the etiology of the cough illnesses was pertussis and to identify the magnitude of the problem. We tested 108 persons with cough from all four schools. Pertussis culture, PCR, and/or serology were performed by the CDC Pertussis Laboratory as appropriate.

Laboratory results provided confirmation that pertussis has been circulating in Cobb County. Of the 108 persons tested, 22 had evidence of recent pertussis infection. A very limited number were determined to be infectious during the time the specimens were collected and are currently being treated and excluded from school. Of the 18 children who tested positive, 17 had documentation of receiving five Dtap vaccines.

Because clinicians represent the front line in pertussis control, we would like to offer the following reminders about pertussis diagnosis and treatment:

Pertussis has been shown to be circulating in Cobb County. Pertussis in both previously vaccinated school age children and adults can have milder, non-classical presentations. The diagnosis of pertussis should be considered in any individual presenting with prolonged cough especially if accompanied by whoop, post-tussive vomiting, or paroxysmal cough, regardless of vaccination history. Pertussis culture is the most specific diagnostic test for pertussis. However, given documentation of pertussis circulation in Cobb County, positive pertussis PCR results should be regarded as definitive. Neither pertussis PCR nor cultures are believed to be sensitive tests after 14 days of cough. In patients with longer cough duration, pertussis serology may help with diagnosis; however, validated serology tests are currently not available commercially.
Appropriate antibiotic therapy given in the first three weeks of cough may shorten cough duration and prevent transmission of pertussis. Persons with pertussis should refrain from close contact with others until they have completed 5 days of antibiotic therapy.
Persons with pertussis who have not been treated are generally not considered infectious after 21 days. Antibiotic therapy is generally not considered useful after this time even though the cough may persist for months.
Patients should be up-to-date on pertussis immunizations, including a Tdap booster after age 11 years.
Please notify your local Health Department or call 866-PUB-HLTH if you identify a suspect or confirmed case.
Recommendations for exclusion of suspect or confirmed cases from school or daycare and/or prophylaxis of contacts will be determined by the local Health Department.

For any questions please contact 404-657-2588 and ask for Dr. Julie Gabel, Dr. Jessica Tuttle, or Beth Ward. Thanks for your assistance.

Sincerely,
Susan Lance, D.V.M., Ph.D.
Director, Office of Protection and Safety, Georgia Division of Public Health

March 25, 2009

WIC Toolkits Available

Georgia’s WIC program is the nation's seventh largest Special Supplemental Nutrition Program for Women, Infants and Children. The Division of Public Health administers the program. Services are provided through our 18 health districts plus two contract agencies. These services include ntrition assessment and education, health screening, medical history, BMI, hemoglobin check, breast feeding support and education. One may apply by contacting either the State WIC Branch, or their local health department.

To learn specifically the data for your area, a county profile analysis is available at http://health.state.ga.us/wic-countyprofiles/index.aspx. The data includes WIC Program Performance measures during the 2007 fiscal year and can be used to determine the value of the WIC Program in each county.

The Georgia Academy of Family Physicians has a WIC Toolkit available for your convenience. You may access the kit via our website at www.gafp.org under the Public Health Resources tab or if you would like a hardcopy, feel free to contact the GAFP office at 404-321-7445, or email cdurham@gafp.org . If you are interested in-office training for you and your staff, please contact cdurham@gafp.org

February 2009

Georgia Public Health Laboratory Cuts Hours

Effective Saturday November 8, 2008 the Georgia Public Health Laboratory (GPHL) discontinued operating on Saturdays, as a result of budgetary reductions. Fortunately, the Newborn Screening Unit of the GPHL will not be closed for more than 2 consecutive days. To accommodate extended holiday weekends, newborn screening testing will be performed on either Saturday or on the actual holiday (see schedule).

If you have any questions, please contact the Newborn Screening Unit of Georgia Public Health Laboratory at:
1749 Clairmont Road
Decatur, Georgia 30033
Telephone: 404-327-7950
Fax: 404-327-7919

2009 Holiday Newborn Screening Testing Schedule
Saturday, January 17, 2009 (MLK Jr. Birthday)
Saturday, April 25, 2009 (Confederate Memorial Day)
Saturday, May 23, 2009 (National Memorial Day)
Friday, July 3, 2009 (Independence Day)
Saturday, September 5, 2009 (Labor Day)
Saturday, October 10, 2009 (Columbus Day)
Saturday, November 28, 2009 (Thanksgiving/Lee’s Birthday)
Saturday, December 26, 2009 (Christmas/Washington's Birthday)

February 2009

Babies Can’t Wait - What a Family Physician Should Know

Babies Can’t Wait is Georgia’s Part C Early Intervention Program under the Federal Individuals with Disabilities Education Improvement Act (IDEA). It is a comprehensive, coordinated, multidisciplinary, interagency system of early intervention support for infants and toddlers with disabilities from birth to age 3.

Children 0-36 months with developmental delay, developmental disabilities, and/or children with certain diagnosed disabling conditions with a high probability of resulting in delays are eligible. The complete list of the diagnoses that result in automatic eligibility for Babies Can’t Wait can be found at http://health.state.ga.us/pdfs/familyhealth/bcw/Category1ConditionsList.pdf

Anyone can refer a child to Babies Can’t Wait, including (but not limited to) parents, social workers, physicians, childcare providers, and teachers. Children 1st is the system point of entry for all Public Health programs for young children in Georgia. Referrals to Babies Can't Wait are made by completing the Children 1st Screening and Referral Form and mailing, faxing, or emailing the completed form to the Children 1st Coordinator in the district which serves the county in which the child resides. This can be found by accessing the complete list of Coordinators at http://health.state.ga.us/pdfs/familyhealth/csncoordinator.2004.pdf

The local Babies Can’t Wait office must acknowledge receipt, in writing, within three working days of receiving the referral. Families who are referred will be contacted by a representative of Babies Can't Wait within a few days following the referral. A date and time will be scheduled for an initial intake appointment. During that initial meeting, families share information about their priorities for their child and are provided information about Babies Can't Wait. Following completion of the intake appointment, the multidisciplinary evaluation and assessment is scheduled at a time that is convenient for the family. If the child is found eligible for services, an Individualized Family Service Plan (IFSP) will be developed with the family. Policy states that the child’s service coordinator, with written parental consent, will provide copies of evaluation reports and the IFSP to you within 15 working days of the evaluation or the IFSP meeting.

Once a part of Babies Can’t Wait, the child’s services will be provided by agencies and individuals from both private and public sectors. These professionals will represent various disciplines including, but not limited to audiologists, counselors, educators, nurses, nutritionists/dieticians, occupational therapists, physical therapists, speech-language pathologists, and/or psychologists. Professionals within all disciplines must meet the educational, licensure, and professional examination requirements established by the state of Georgia. Evaluation/assessment, service coordination, development of the IFSP and procedural safeguards are provided at no cost to families. The Children with Special Needs Financial Analysis Form is completed on all families prior to the development of the IFSP to determine the family’s assignment of cost participation/ability to pay for services outlined on the IFSP. In addition, with written parental consent, private insurance, Medicaid, CMOs and other insurance coverage also assist in covering the cost of services with Babies Can’t Wait being the pay or of last resort.

As the child's physician, you are encouraged to participate in all aspects of the child's and family's early intervention experience, beginning with referral and continuing through determination of eligibility, IFSP development, service delivery and transition out of BCW at age three. When a child reaches his or her third birthday, the family’s service coordinator will assist them in learning what resources may be available to them. These include services such as Georgia’s Department of Education Division for Exceptional Students and Bright from the Start’s Head Start. For more information contact 404-657-2726.

January 19, 2009

You Should Know About These 2008-09 Flu Vaccine Changes

According to an article in Georgia Epidemiology Report, the 2008 Advisory Committee on Immunization Practices (ACIP) has recommended four major changes from last year:

6 All children ages 5-18 should be vaccinated annually, if feasible;

6 Children ages 6 months to 4 years (and older) who are at risk for complications from influenza should continue to be the primary focus of vaccination efforts.

6 Either trivalent inactivated vaccine (TIV) or live, attenuated vaccine (LAIV) can be used for healthy people between the ages of 2 and 49.

Children 6 months to 8 years should receive two doses, the second at least four weeks after the first, if they have never been vaccinated with the LAIV or TIV.

Children 6 months to 8 years who received only one dose in their first year of vaccinations should receive two doses the following year, with the second dose at least four weeks after the first. Children with RAD should not receive LAIV.

Children with underlying medical conditions that put them at risk for influenza complications, children 6 to 23 months old and people older than 49 should receive TIV.

6 The trivalent vaccine virus strains for 2008-2009 are: A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like and B/Florida/4/2006-like antigens(1).

Reference: Centers for Disease Control and Prevention. Prevention and Control of Influenza; Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008. MMWR 2008; 57 (No. RR-7)[pp: 1-60].

January 19, 2009

Woman's Right To Know - New 2007 Provisions

During the 2007 legislative session, House Bill 147 passed, which builds upon the requirements of House Bill 197, the "Woman's Right to Know" (WRTK) Act.

HB 147 requires that in all cases in which an ultrasound is performed prior to conducting an abortion, or a pre-abortion screen, the pregnant woman must be offered the opportunity to view the ultrasound and listen to the fetal heart rate. Although they are not required to view or to listen, this opportunity must be extended, and a completed consent placed in the chart signed by the woman indicating individually whether she declined or accepted to:
1. View the ultrasound
2. Listen to the heart beat

Medical providers in licensed abortion facilities who provide information to pregnant women under these laws must continue to submit the WRTK Annual Reporting form, as they did previously, by February 28, 2009.

The additional reporting requirements related to ultrasound can be accessed at http://health.state.ga.us/wrtk/

If you have questions, comments or suggestions regarding the updated requirements, please feel free to contact the Office of Birth Outcomes, Perinatal/ Women's Health Unit at (404) 657-3143 or by email at wrtkinfo@dhr.state.ga.us

December 5, 2008

Influenza Sentinel Providers – Contributing to the Public’s Health

What is an influenza sentinel provider? An influenza sentinel provider conducts surveillance for influenza-like illness (ILI) in collaboration with the local and state health departments as well as the Centers for Disease Control and Prevention. Data reported by sentinel providers, in combination with other influenza surveillance data, provide a picture of influenza virus and ILI activity in the United States. Approximately 2,400 providers throughout the country were enrolled in this network during the 2007-2008 influenza season; 77 of them were Georgia sentinel providers.

What data do sentinel providers collect? Sentinel providers report the total number of patient visits each week and the number of patient visits for influenza-like illness by age group (0-4 years, 5-24 years, 25-64 years, >65 years).

How and to whom are data reported? These data are transmitted once a week over the Internet or via fax to CDC. Most providers report that it takes them less than 30 minutes a week to compile and report their data. In addition, sentinel providers submit specimens from a subset of patients for virus isolation free of charge three times during the influenza season. The Georgia Public Health Laboratory types the viruses; many of these are then forwarded to CDC for viral characterization.

Who can be an influenza sentinel provider? Providers of any specialty (for example, family practice, internal medicine, pediatrics, infectious diseases) in any type of practice (private practice, public health clinic, urgent care center, emergency room, university student health center, occupational medicine) are eligible to be sentinel providers.

Why volunteer? Influenza viruses are constantly evolving and cause substantial morbidity and mortality (approximately 36,000 deaths) almost every winter. Data from sentinel providers are critical for monitoring the impact of influenza and, in combination with other influenza surveillance data, can be used to guide prevention and control activities, vaccine strain selection and patient care.

Sentinel providers receive feedback on the data submitted, summaries of regional and national influenza data and free subscriptions to CDC’s Morbidity and Mortality Weekly Report and Emerging Infectious Diseases Journal. The most important consideration is that the data provided are critical for protecting the public’s health. For more information on influenza sentinel provider surveillance, please contact Ariane Reeves, RN, BSN, MPH, CIC – Influenza Surveillance Coordinator for the Georgia Division of Public Health – at 404 -463-4625 or alreeves@dhr.state.ga.us.

November 20, 2008

Georgia Partnership For Caring Provides Medications For Your Uninsured Patients

Did you know that the Georgia Partnership for Caring pharmacy program provides a basic formulary of 100 medications that fight chronic diseases such as diabetes, epilepsy, glaucoma, hypertension, hyperlipidemia and hypothyroidism? There also are several antibiotics and antifungals on the formulary, as is Azmacort, a maintenance medication for asthma. The formulary of Novo Nordisk insulin includes Levemir.

Your uninsured patients with family income within 150 percent of the federal poverty level can qualify by submitting an application through the Right from the Start Medicaid outreach worker for your county or by faxing a completed application, with proof of income attached, to the partnership office at (678) 578-2930. When the application is approved, a letter will be sent to the applicant with a pharmacy card and instructions on how to use it to have prescriptions filled at a local pharmacy at no charge.

All Kroger pharmacies in Georgia and many independent pharmacies across the state dispense for the partnership program. The program’s toll-free information number, (800) 982-4723, is answered from 8:30 a.m. to 4:30 p.m., Monday through Friday, except for holidays.

For more information, call partnership Executive Director Tom Underwood at (678) 578-2926.

September 4, 2008

MRSA Increases In Georgia

Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) is becoming increasingly prevalent in Georgia. The overall incidence of invasive CA-MRSA disease has increased from 1.1 cases per 100,000 Georgians in the eight-county Atlanta metropolitan area in 2001 to 5.2 cases per 100,000 in 2005. These rates are highest among children younger than 1 and adults older than 65.

In 2004, the Georgia DHR, Division of Public Health, mandated that all severe CA-MRSA infections be reported. Most CA-MRSA infections are uncomplicated. However, cases in which MRSA is isolated from a sterile site and results in intensive care, operative debridement, the death of a person with no prior history of MRSA infection, hospitalization or surgery, dialysis, or is isolated from percutaneous medical devices or has a history of long-term residential care, should be considered severe and be reported to (866) PUB-HLTH or through the State Electronic Notifiable Disease Surveillance System (SENDSS). In addition, any outbreaks or clusters of MRSA infections, even if not severe, should be reported to your local health department.

Despite most CA-MRSA infections being uncomplicated skin and soft tissue infections, the fact that the bacteria is widespread in Georgia makes it a significant public health concern. The CDC has defined “the five Cs” of CA-MRSA risk factors as: crowding, close contact, compromised skin, contaminated surfaces and shared personal items, and lack of cleanliness. Because severe infections are preceded by antimicrobial use in some areas, poor usage of these medications could also be considered a risk factor.

A wealth of information on MRSA prevention and treatment can be found at http://health.state.ga.us/MRSA/.

September 4, 2008

Summer Food Service Program for Needy Children
Most schools in Georgia have adjourned for the school year. This means that children who have been fed at school under the school lunch program and the school breakfast program will have to find other alternatives for securing these meals. One viable program is the Summer Food Service Program (SFSP) sponsored by USDA and the State of Georgia -Department of Early Care and Learning. The SFSP is operated in local communities by school boards, YMCAs, churches and faith- based groups, community recreation centers, and other non-profit entities. Find local sites

August 6, 2008

Public Health/Physician Partnerships Protect Your Patients
Contributed by the Department of Human Resources - Public Health Liaison Program

In a busy doctor’s office, it’s easy to forget that each health care provider is the foundation of the global Public Health system, but in every community throughout Georgia, district epidemiologists and Public Health liaisons are working closely with health care clinicians to find ways to better serve their patients while protecting their communities. Early in their medical training, physician providers learn about epidemiology – the study of diseases and the science of Public Health. To obtain information about diseases, epidemiologists need to hear from physicians on the front lines. Public Health relies on primary care physicians and clinical laboratories to be the eyes and ears of what is going on in the community. Georgia law (O.C.G.A. 31-12-2) requires that all physicians, laboratories and other health care providers report patients who have one of 70 illnesses or conditions to Public Health. The list of conditions can be found at http://health.state.ga.us/pdfs/epi/notifiable/notifiableposter.05.pdf. Reports can be submitted through a secure Internet-based system called SendSS (State Electronic Notifiable Disease Surveillance System - https://sendss.state.ga.us), by completing a notifiable disease reporting form (http://health.state.ga.us/pdfs/epi/notifiable/reportingform.05.pdf) or by calling the local health department. Information including lab results, patient demographics, symptoms and treatment are then collected by epidemiologists.

Every disease that is reported has specific follow-up requirements. For some diseases, such as tuberculosis, meningococcal meningitis and certain sexually-transmitted diseases, contacts of the patient will also need evaluation and possibly prophylaxis or treatment. Public Health will interview the patient, collect information about these contacts and facilitate treatment, if necessary. Although most disease reports are submitted following laboratory confirmation, physicians should report any suspect clinical cases or any unusual increases in diseases to Public Health. Again, we rely on the eyes and ears of our community partners. With the increased focus on bioterrorism, a physician may be the first to notice unusual or rare symptoms. The sooner a disease or condition is reported to Public Health, the sooner measures can be taken to stop or limit the spread.

A cluster, defined as two or more cases of an illness linked in place and time, is reportable to Public Health even if it is not laboratory confirmed or technically a notifiable disease. Some clusters can lead to outbreak investigations. Usually, some common factor is identified, such as shared living quarters, shared personal items, a food source or a community activity. An outbreak investigation often takes many agencies working together to implement measures that may be needed to decrease the spread of disease.

In addition to the passive form of notifiable disease surveillance described above, Public Health relies on supplementary surveillance systems such as syndromic surveillance, defined as the collection and interpretation of nonclinical data, such as absentee rates, chief complaint data or over-the-counter medication sales. At designated syndromic surveillance sites, such as some hospital emergency departments, chief complaint data are collected without patient identifiers and then collated, compared and analyzed for increases in syndromes that might represent an outbreak. If an aberration is noted, the syndromic surveillance site is contacted for further information.

One of the most important ways clinicians can have an impact on Public Health is through the CDC Influenza-Like-Illness Sentinel Surveillance System. The providers who participate in this system provide the data that determines everything from the flu activity levels to the viral strains included in the seasonal influenza vaccine and are critical in the early detection of a potential pandemic strain of influenza.

Several items in the news recently have brought focus on Public Health. In the fall, we received many calls about methicillin-resistant staphylococcus aureus (MRSA). While MRSA has been documented in health care settings for about 50 years, there is now a strain called community-associated MRSA (CA-MRSA). Only severe CA-MRSA infections are reportable to Public Health, such as when they result in hospitalization or death.

All active tuberculosis cases are reportable to Public Health, as are latent tuberculosis infections in children under 5. Tuberculosis is one of the diseases in which Public Health staff locate and evaluate contacts. As soon as a positive culture for mycobacterium tuberculosis is identified, the isolate is tested for drug susceptibility. The Georgia Public Health Lab will evaluate the isolate for single drug resistance, multidrug resistance (MDR) or extreme multidrug resistance (XDR). It is crucial to identify drug resistance as early as possible in order to ensure appropriate treatment.

Public Health liaisons are working closely with health care providers in every Georgia community to enhance the Public Health system by improving disease reporting and connecting providers to resources that will help provide better service to their patients. Providers and Public Health have the same goals, and, in partnership, they assure the health of the people in their community.

To learn more about disease reporting or other public health resources, contact your local Public Health liaison or district epidemiologist. To find your local public health office, go to www.gafp.org and click on Public Health Resources, drag the menu down to Other Resources, then click on District Director Contact Information.

June 13, 2008